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Testicular Cancer Diagnosis and Treatment - A Detailed Guide

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Procedures or Tests for Testicular Cancer Diagnosis

There are multiple tests available for the diagnosis of testicular cancer. These tests help in diagnosis, staging, and treatment planning, too. Some of the common tests for testicular cancer diagnosis are:

Medical History and Physical Examination

The patients undergo a detailed medical history assessment and physical examination to find the cause of the symptoms. A physical examination includes evaluating the scrotum for any sign of swelling or the presence of a lump. The belly and the surrounding lymph nodes are also examined to rule out the spread of cancer. It is important to inquire about the family history of the patients, as certain conditions, such as Klinefelter's syndrome, increase the risk of testicular cancer. The doctors may also ask about the family history of cancers, including testicular cancer, as it is one of the risk factors for this cancer type. If the doctor suspects the presence of testicular cancer, the patients are advised to undergo further testicular cancer tests.

Ultrasound

It has been reported that ultrasound combined with physical examination has almost 100% sensitivity for testicular cancer diagnosis. Testicular cancer in ultrasound is viewed as solid and vascularized intratesticular lesions. It is also important to note that different types of testicular cancers have subtle differences in morphological characteristics when seen on ultrasound images. Normal testicles look even and smooth on ultrasound. Any shadow generally indicates the presence of cancer. Ultrasound differentiates between the intra- and extra-testicular lesions and is often performed before orchiectomy. However, it is not recommended for staging testicular cancer in patients with advanced disease (metastatic cancer).

Blood Tests

Several proteins are produced by testicular cancer cells. The doctor may advise the patients to undergo blood tests to determine the level of these proteins. This test is known as the tumor marker test, which looks for the presence and levels of alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (HCG), and lactate dehydrogenase in the blood. Blood tests are not recommended for the confirmatory diagnosis of testicular cancer, as elevated levels of these substances may also be due to other conditions. It has been reported that pure seminomas occasionally increase HCG levels, but AFP levels are never elevated. However, non-seminomas generally raise the levels of AFP and/or HCG.

Biopsy

A biopsy is a test that involves obtaining a tissue sample from the abnormal site and examining it under the microscope for the presence of cancer. A biopsy is usually the confirmatory diagnostic test for various types of cancer. However, it is rarely performed to detect testicular cancer due to the risk of spreading it. The combination of physical examination, ultrasound, and tumor marker tests provides a fair idea about the presence of testicular cancer, and the oncologist may recommend the patients undergo orchiectomy (surgical removal of affected testicles) as soon as possible. A study found that trans-scrotal biopsy has a significantly higher risk of local recurrence than orchiectomy.

CT (Computed Tomography) Scan

Computed tomography plays an important role in various aspects of testicular cancer. It assists in the accurate staging of testicular cancer. It is also the preferred imaging technique for monitoring the response of testicular cancer therapy and the recurrence of testicular cancer. A CT scan also allows the surgeons to plan the removal of the residual masses and detect the extent of tumor spread after recurrence. The oncologists may also perform CTs of the pelvis, abdomen, and chest. A CT of the brain is usually not required (unless the patient has a neurological presentation), as the spread of testicular cancer to the brain is not very common.

Chest X-ray

A chest x-ray is performed in patients with testicular cancer who are suspected of cancer in the lungs. Chest X-rays assist oncologists in the staging of testicular cancer. A study comparing chest radiography and chest CT found a preference for chest radiography in patients with seminoma and non-seminomatous germ cell tumors.

MRI (Magnetic Resonance Imaging)

Although a CT scan provides high-quality, detailed images of the retroperitoneum, high radiation doses are required, and because of the relatively younger age of the patients developing testicular cancer, MRI is usually a modality of choice for evaluating the retroperitoneal lymph node. However, several barriers, such as a relatively longer scanning time, a shortage of radiologists who are experts in interpreting retroperitoneal MRI, and a higher cost, prevent MRI from becoming the preferred modality for detecting testicular cancer. However, as MRI provides high-quality images of the spinal cord and brain, it is recommended if the oncologist believes that testicular cancer has metastasized to the brain.

Radical Inguinal Orchiectomy

Radical inguinal orchiectomy is a procedure that involves the surgical removal of one or both testicles by making an incision in the pubic area. It serves two important functions. First, it removes the abnormal testicle and lowers the risk of cancer metastasis. Second, it helps obtain tissue for histopathological diagnosis. The examination provides detailed information about the presence, type, and extent of cancer.

Bone scan

If the patient diagnosed with testicular cancer has bone-related symptoms, such as bone pain, the oncologists may recommend a bone scan. Bone scintigraphy is implemented for the early detection of testicular cancer metastasis. It has been reported that conventional radiography has lower sensitivity than nuclear techniques for detecting cancer metastasis.

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What are Effective Testicular Cancer Treatments?

Upon arriving at a conclusive diagnosis of testicular cancer, it is further staged before devising a personalized treatment plan. While creating a treatment plan, specialists consider a myriad of factors, such as the type of testicular cancer, its stage, its size, the patient’s age and overall health status, and the patient’s preferences. Some of the testicular cancer treatments include:

Surgery

Surgery is the primary treatment option for all types of testicular cancers. The surgery removes one or both the testicles and/or the affected lymph nodes. The types of testicular surgeries are:

Radical Inguinal Orchiectomy

Radical inguinal orchiectomy is a testicular cancer medical procedure that involves the surgical removal of one (unilateral orchiectomy) or both the testicles (bilateral orchiectomy). During this procedure, an opening is made in the pubic area through an incision, and the testicle is removed from the scrotum. The surgeon removes the complete tumor along with the spermatic cord. The spermatic cord contains blood vessels and lymph vessels. These vessels are tied before surgery to minimize the risk of spreading cancer.

Retroperitoneal Lymph Node Dissection (RPLND)

Not all patients with testicular cancer have to undergo lymph node dissection. The oncosurgeons may remove the lymph nodes at the back of the abdomen surrounding the large blood vessels during orchiectomy or a separate surgery, depending upon the stage and type of cancer. The lymph node is removed through open surgery or laparoscopic surgery. During open surgery, the surgeon creates a large cut on the abdomen and removes the lymph nodes. In laparoscopic surgery, the surgeon makes a few small incisions and removes the lymph nodes through small instruments guided by a laparoscope.

Chemotherapy

It is a testicular cancer treatment approach that uses medicines to kill the cancer cells. This testicular cancer therapy involves administering powerful drugs, also known as chemotherapy drugs, orally or intravenously. Chemotherapy drugs interfere with the vital processes in the cell cycle of cancerous cells and kill them. Chemotherapy may be used in combination with radiation therapy or surgery.

Adjuvant Chemotherapy

Adjuvant chemotherapy for testicular cancer is done after the surgery to kill the cancer cells that are not removed by the surgery. Adjuvant chemotherapy aims to reduce the risk of cancer recurrence.

Primary Chemotherapy

Primary testicular cancer chemotherapy is the administration of testicular cancer medications before localized treatment, such as radiation therapy or surgery. It is done to shrink the tumor so that it can be easily destroyed by radiation or easily removed through surgery.

Radiation Therapy

During radiation therapy as a testicular cancer treatment, the cancer cells are killed through high-energy radiation, such as X-rays or gamma rays. As a part of a treatment strategy for testicular cancer, radiation therapy is used in cases where the disease has metastasized to the lymph nodes. Seminoma-type testicular cancer is highly sensitive to radiation therapy. It may be used in combination with surgery or radiation therapy.

Immunotherapy

Immunotherapy involves delivering drugs that interfere with the immune system-evading process of cancer cells. These drugs make the cancer cells more vulnerable to the immune system. The immune system identifies the cancer cells and kills them. As immunotherapy targets the procedure specific to cancer cells, this therapy has fewer side effects than chemotherapy.

Why Choose HCG for Testicular Cancer Diagnosis and Treatment?

HCG Cancer Center has all the required facilities for diagnosis, management, and post-surgical care for patients with testicular cancer. The center has advanced imaging testing facilities, including MRI, CT, ultrasound, and PET scans. Further, various treatment options, including surgery, chemotherapy, radiation therapy, and immunotherapy, are available at the center. The center also delivers the services of extensively experienced medical oncologists and oncology surgeons.

Conclusion

The diagnostic methods for testicular cancer include physical examination and medical history, imaging techniques, testicular cancer surgery, and tumor marker tests. Testicular cancer treatment options include chemotherapy, radiation therapy, surgery, and immunotherapy. Testicular surgery types include orchiectomy and lymph node dissection.

Frequently Asked Questions

Can testicular cancer be cured permanently?

The permanent treatment for testicular cancer depends on the stage of diagnosis. If diagnosed very early, testicular cancer can be treated successfully. However, once the treatment is completed, patients should be monitored at regular intervals after treatment.

There is a high testicular cancer survival rate. However, the overall survival period depends upon several factors, such as the stage of diagnosis, response to testicular cancer treatment, and the overall patient's health.

Yes, testicular cancer may relapse in some patients. In some cases, non-seminoma cancer relapses within two years of chemotherapy or surgery, and seminoma recurs within three years.

It depends on the type of symptoms. If the symptoms are swelling and a lump in the scrotum, it can be detected easily.

A combination of physical examination, ultrasound, and tumor marker testing assists in confirming the diagnosis of testicular cancer. A biopsy is usually not recommended for a definitive testicular cancer diagnosis.